Prenatal diazepam induced persisting downregulation of peripheral (omega 3) benzodiazepine receptors on rat splenic macrophages

Delayed developmental immunotoxicity of prenatal benzodiazepines

Treatment of pregnant rats with low doses of classical benzodiazepines (BDZ, e.g. 1.25 mg diazepam/kg body weight) or a peripheral type BDZ receptor (PBR) agonist between gestational days 14 and 20 has been shown to result in a long-lasting depression of cellular and humoral immune responses in the offspring. Considerable alterations in mitogen-stimulated cytokine production in rats exposed to diazepam prenatally have now been observed: TNF-alpha liberation by splenocytes of diazepam-exposed rats was reduced at 2 wk of age and increased above control values at 8 wk, and interleukin (IL)-6 was depressed in the offspring at 2 and 8 wk of age. IL-1 was diminished during post-weaning and adult periods in male offspring but only in adult life in female offspring. In contrast, T-cell derived IL-2 was decreased during the postnatal period and normalized in adulthood. Prostaglandin E(2) (PGE(2)), which is known to down-regulate tumour necrosis factor-alpha (TNF-alpha) was increased and interferon-gamma (IFN-gamma), which stimulates TNF-alpha release, was depressed in 2-wk-old offspring that had been treated prenatally. Release of PGE(2) and IFN-gamma was still altered in young adulthood. While the initial action on the foetal immune system remains unknown, an interaction of the drugs with the PBR is suggested by the effectiveness of the PBR agonist and by altered characteristics of PBR (i.e. a decreased B(max) of [(3)H]PK 11195 binding to macrophage membranes of 8-wk-old offspring and an increased Kd of spleen cell membranes of 2-wk-old offspring).

Microglial imaging with positron emission tomography and atrophy measurements with magnetic resonance imaging in multiple sclerosis: a correlative study

OBJECTIVE

The objectives of the present study were to assess brain atrophy in multiple sclerosis (MS) patients during different disease stages and to investigate by PET and [11C]PK11195, a marker of microglial activation, the relationship between inflammation, atrophy and clinically relevant measures.

METHODS

Eight healthy subjects and 22 MS patients were included. Semiquantitative [11C]PK11195 uptake values, with normalization on cortical grey matter, were measured for magnetic resonance imaging T2- and T1-lesions and normal appearing white matter (NAWM). As atrophy index we used the ratio of the amount of white and grey matter divided by the ventricular size, using an optimized a priori based segmentation algorithm (SPM99).

RESULTS

Atrophy was significantly greater in MS patients compared to age-matched controls. A significant correlation was found between brain atrophy and both disease duration and disability, as measured with the Expanded Disability Status Scale. For NAWM, [11C]PK11195 uptake increased with the amount of atrophy, while T2-lesional [11C]PK11195 uptake values decreased according to increasing brain atrophy.

CONCLUSIONS

The present study suggests that brain atrophy, correlating with disease duration and disability, is directly related to NAWM and T2-lesional inflammation as measured by microglial activation.

Structural Effects and Neurofunctional Sequelae of Developmental Exposure to Psychotherapeutic Drugs: Experimental and Clinical Aspects

The advent of psychotherapeutic drugs has enabled management of mental illness and other neurological problems such as epilepsy in the general population, without requiring hospitalization. The success of these drugs in controlling symptoms has led to their widespread use in the vulnerable population of pregnant women as well, where the potential embryotoxicity of the drugs has to be weighed against the potential problems of the maternal neurological state. This review focuses on the developmental toxicity and neurotoxicity of five broad categories of widely available psychotherapeutic drugs: the neuroleptics, the antiepileptics, the antidepressants, the anxiolytics and mood stabilizers, and a newly emerging class of nonprescription drugs, the herbal remedies. A brief review of nervous system development during gestation and following parturition in mammals is provided, with a description of the development of neurochemical pathways that may be involved in the action of the psychotherapeutic agents. A thorough discussion of animal research and human clinical studies is used to determine the risk associated with the use of each drug category. The potential risks to the fetus, as demonstrated in well described neurotoxicity studies in animals, are contrasted with the often negative findings in the still limited human studies. The potential risk fo the human fetus in the continued use of these chemicals without more adequate research is also addressed. The direction of future research using psychotherapeutic drugs should more closely parallel the methodology developed in the animal laboratories, especially since these models have already been used extremely successfully in specific instances in the investigation of neurotoxic agents.

Effects of acute and long-term diazepam administrations on neutrophil activity: a flow cytometric study

This study analyzed the effects of acute and long-term diazepam treatments on rat peripheral blood neutrophil activity and cortisol serum levels. Rats were acutely and long-term (21 days, once daily) treated with diazepam (10 mg/kg) or its vehicle (1.0 ml/kg). Blood was collected 1 h after treatments for flow cytometric analysis of neutrophil oxidative burst and phagocytosis. Corticosterone and diazepam concentrations were also determined. Results showed that: (1) both diazepam treatments increased lipopolysaccharide (LPS) and phorbol myristate acetate (PMA)-induced neutrophil oxidative burst; (2) the increase in oxidative burst after Staphylococcus aureus induction in acutely treated animals was higher than that observed after long-term treatment; (3) phagocytosis is increased by acute diazepam treatment and decreased by a long-term regimen; (4) acute, but not long-term, diazepam treatment increased corticosterone levels; (5) diazepam plasmatic levels after acute and long-term treatments were not different. These results indicate the development of tolerance to diazepam effects on corticosterone serum levels but not on neutrophil activity.

PET visualization of microglia in multiple sclerosis patients using [11C]PK11195

Activated microglia are involved in the immune response of multiple sclerosis (MS). The peripheral benzodiazepine receptor (PBR) is expressed on microglia and up-regulated after neuronal injury. [11C]PK11195 is a positron emission tomography (PET) radioligand for the PBR. The objective of the present study was to investigate [11C]PK11195 imaging in MS patients and its additional value over magnetic resonance imaging (MRI) concerning the immuno-pathophysiological process. Seven healthy and 22 MS subjects were included. Semiquantitative [11C]PK11195 uptake values were assessed with normalization on cortical grey matter. Uptake in Gadolinium-lesions was significantly increased compared with normal white matter. Uptake in T2-lesions was generally decreased, suggesting a PBR down-regulation. However, uptake values increased whenever a clinical or MR-relapse was present, suggestive for a dynamic process with a transient PBR up-regulation. During disease progression, an increase of normal-appearing white matter (NAWM) uptake was found, propagating NAWM as the possible real burden of disease. In conclusion, [11C]PK11195 and PET are able to demonstrate inflammatory processes with microglial involvement in MS.

Prenatal diazepam exposure functionally alters the GABA(A) receptor that modulates [3H]noradrenaline release from rat hippocampal synaptosomes

In rats, exposure to diazepam (DZ) during the last week of gestation is associated with behavioral alterations (in some cases sexually dimorphic) that appear when the animals reach adulthood. This study was conducted to evaluate the effects of prenatal DZ exposure on the function of the gamma-aminobutyric (GABA)(A) receptor complex. The method used - perfusion of rat hippocampal nerve terminals labeled with [3H]noradrenaline (NA) - allowed us to evaluate the effects of DZ on a specific native GABA(A) receptor subtype which is located on hippocampal noradrenergic nerve endings and mediates the release of NA. Muscimol stimulated synaptosomal release of [3H]NA in a concentration-dependent manner; maximal stimulation (50%) was achieved with a concentration of 30 microM, and the ED(50) was 1.7 microM. The effect of muscimol was potentiated by the positive allosteric modulators DZ and 3alpha-pregnan-5alpha-ol-20-one (3alpha,5alpha-P; allopregnanolone), which displayed similar maximal effects and affinities. In the presence of DZ (0.1 microM), muscimol stimulated the release of [3H]NA with an ED(50) of 0.5 microM; in the presence of 3alpha,5alpha-P (0.1 microM), the ED(50) of muscimol was 0.3 microM. Prenatal DZ exposure did not modify the concentration-effect curve for muscimol, but it did abolish the potentiating effects of DZ and 3alpha,5alpha-P. These findings demonstrate that prenatal exposure to DZ produces functional modifications of the GABA(A) receptor subtype we investigated. This effect may be related to the relative contributions of the various protein subunits that compose the GABA(A) receptor complex. Exposure to DZ while the GABA(A) receptors are developing might influence the expression of these subunits, giving rise to a receptor that can be activated by muscimol but is not susceptible to allosteric modulation by DZ or 3alpha,5alpha-P.

Sex-specific effects of in utero manipulation of GABA(A) receptors on pre- and postnatal expression of BDNF in rats

Exposure to diazepam (DZ) during the last week of in utero development in rats induces neurobehavioral effects that do not become apparent in exposed animals until young adult ages. Some of the effects are sex specific. This study evaluated the hypothesis that late gestational exposure to DZ, a positive modulator of GABA(A) receptors, affects the developmental appearance of brain-derived neurotrophic factor (BDNF), an effect that could be linked to the later consequences of the exposure. Pregnant Long-Evans rats were injected with DZ (2.5 mg/kg) over gestation days 14-20, and their male and female offspring were evaluated for levels of BDNF mRNA and protein in the cerebral cortex and hypothalamus at fetal day 20 and at postnatal ages spanning birth to young adulthood. The effects of the exposure were sex and region specific. At fetal day 20 the expression of BDNF was reduced by about 20% in the hypothalamus of males only. The early exposure affected postnatal expression of BDNF in the hypothalamus only modestly, influencing the age-related profile in both sexes. Postnatal development of BDNF in the cerebral cortex was significantly affected by the in utero exposure in males only with mRNA levels lower in the exposed group and protein levels higher during juvenile ages. At adulthood, both levels were lower in DZ-exposed males. GABA serves a role as a trophic factor during early development, and these results suggest that manipulation of GABA(A) receptors during early development could interact with the developmental action of other trophic factors thereby leading to altered neural organization and later neurobehavioral dysfunction.

Sex differences in long-term consequences of prenatal diazepam exposure: possible underlying mechanisms

Prenatal exposure to diazepam, a benzodiazepine (BZD) compound, leads to pronounced effects on responses to stressors in exposed animals when they reach adulthood. Many of the responses are sex specific. The mechanisms mediating the effects of the exposure on the organism have not been elucidated; however, the time course for the appearance of altered function following in utero drug exposure indicates that the exposure interfered with neural organization of mechanisms mediating responses to stressors. The article discusses possible mechanisms that relate to sites of action of the drug in the developing brain: the GABA(A) receptor, and the mitochondrial BZD receptor. The mechanisms mediating the sex-specific impact of diazepam on the developing brain appear to be complex and interactive.

Benzodiazepine receptors and avian macrophage activity: diazepam decreases spreading and phagocytosis

The complex interrelations between the nervous system and the immune system have led to the creation of a new research area denoted neuroimmunology. The effects of stress on the immune response have long been observed in chickens. Since benzodiazepine receptors are involved in the stress reaction, we proposed to assess the importance of these receptors in the activity of chick peritoneal macrophages. We used 420 viable embryonated eggs of the commercial Hubbard broiler line treated through the chorioallantoid membrane on the 11th day of incubation: falsely manipulated (Sham group), with 40% propyleneglycol (PG) in simple Ringer solution (Vehicle group), and treated with diazepam (DZ), 8 mg/kg (DZ group). After hatching, the chicks were housed in metal rearing cages of the "battery" type for 5 weeks. At 36 days of age, 24 chicks from each treated group were divided at random into two groups of 12 animals each which were treated with DZ (2 mg/kg) or with 40% PPG in an equal volume once a day by the oral route for 4 days. Peritoneal macrophages were collected and submitted to the spreading an phagocytosis tests. Data were analyzed statistically using the SAS software (p < 0.05). Administration of DZ in ovo did not cause a significant decrease in egg hatchability, birth weight or performance parameters during the 5 weeks of assessment. However, the rate of macrophage spreading and phagocytosis was reduced. When administered at 40 days of age, DZ did not change the spreading rate but reduced the phagocytosis rate. There was no interaction between treatments. These results indicate that benzodiazepine receptors seem to be important for macrophage activity also in birds, as previously observed in rodents and primates. Since benzodiazepine receptors are involved in the response to stress, it is possible that the effects of stress on avian immunity may be mediated in part by these receptors.

Effects of diazepam on Mycobacterium bovis-induced infection in hamsters

The in utero exposure of hamsters to low doses of diazepam results in impaired host defense against Mycobacterium bovis during adulthood. Delayed developmental immunotoxicity, however, represents a specific situation that might not be general. The present experiment was undertaken to investigate the effects of diazepam on hamster resistance to M. bovis using adult animals. The effects of diazepam treatment on serum cortisol levels were also studied. Adult hamsters (N = 10 for each group) were treated with diazepam (E1 = 1. 0, E2 = 2.0 or E3 = 3.0 mg kg-1 day-1 subcutaneously) or with control solution (C) for 30 days. Seven days after the beginning of the treatment, the animals received identical inoculum concentrations of M. bovis. Hamsters treated with the higher (2.0 and 3.0 mg kg-1 day-1) doses of diazepam exhibited: 1) increased granuloma areas in the liver (C = 1.81 +/- 1.39, E2 = 10.29 +/- 4.64 and E3 = 15.80 +/- 4.82) and lung (C = 0.54 +/- 0.55, E2 = 6.28 +/- 3.85 and E3 = 6.31 +/- 3.56) and 2) increased scores of M. bovis colony-forming units isolated from liver (C = 2.0, E2 = 3.0 and E3 = 3.5), lung (C = 1.0, E2 = 3.0 and E3 = 3.5) and spleen (C = 1.0, E2 = 2.5 and E3 = 4.0). These effects were dose dependent, and were not detected or were less severe in animals treated with the lowest (1.0 mg/kg) dose of diazepam as well as in those of the control group. Furthermore, diazepam treatment (3.0 mg kg-1 day-1 for 30 days) increased (E3 = 71.32 +/- 2.99; N = 10) the serum levels of cortisol compared to control hamsters (C = 22.61 +/- 2.75; N = 10). The present data, that demonstrate an impaired defense against M. bovis in adult hamsters treated with diazepam, were tentatively explained on the basis of a direct and/or indirect action of diazepam on the cytokine network. The effects may be related to stimulation of peripheral benzodiazepine receptor binding sites (PBR) by macrophages and/or lymphocytes, or they may be mediated by PBR stimulation of the adrenals.

Developmental, neuro and immunotoxic effects of perinatal diazepam treatment in rats

In utero exposure of rats to low dosages of diazepam (1.0-2.0 mg/kg) has been found to result in depression of the cellular and humoral immune responses during adulthood. Behavioral dysfunctions were also reported in infants from mothers with high benzodiazepine (BDZ) intake during pregnancy. The present experiment was undertaken to reconsider the potential action of diazepam during ontogeny in order to obtain further information about developmental processes using a refined methodology. Time-pregnant rats were treated subcutaneously with diazepam (2.0 mg/kg/day,: group E1) or with diazepam vehicle (group C1) from gestational day 14 to 20. Other dams (group E2) received the same BDZ dose from the 1st to the 21st day of lactation (weaning) or were not treated, remaining undisturbed in their home cages (group C2). The following results were obtained for animals perinatally treated with diazepam compared to groups C1 and C2: 1--increased time for testis descent and decreased time for vaginal opening (group E2); 2--no changes in the dates for ear end eye opening, or incisor tooth eruption (groups E1 and E2); 3--increased locomotor activity in the open-field (group E2) and/or in the plus maze (groups E1 and E2); 4--decreased levels of anxiety measured in the plus maze (groups E1 and E2); 5--decreased macrophage spreading and phagocytosis (groups E1 and E2). These results, which occurred in the absence of overt signs of maternal or fetal toxicity, demonstrate developmental, neuro- and immunotoxic effects of perinatal diazepam treatment in rats.

Effects of prenatal diazepam treatment on Mycobacterium bovis-induced infection in hamsters

In utero exposure of rats to low dosages of diazepam has been found to result in depression of cellular and humoral immune responses during adulthood, with marked changes in macrophage spreading and phagocytosis. The present experiment was undertaken to investigate the resistance of adult hamsters to Mycobacterium bovis after prenatal exposure to diazepam. Time-pregnant hamsters were exposed to diazepam (1.0 or 1.5 mg kg(-1) day(-1) subcutaneously) or vehicle from gestational day 9 to 15. A total of 36 different litters (12 of them control and 12 for each experimental group) born after a 16/17-day gestation were used. One male from each litter was infected twice with identical inoculum concentrations of M. bovis at 75 and 107 days of age. This infection model involves the participation of macrophages and T and B cell populations. The animals prenatally exposed to the higher (1.5 mg/kg) dose of diazepam exhibited: (1) increased weight loss, (2) increased mortality, (3) increased granuloma areas measured in the liver, lung and spleen, (4) increased spleen weight, and (5) increased scores of M. bovis colony forming units (CFU) isolated from liver, lung and spleen. These effects were dose-dependent, and were not detected or were less severe in animals treated with the lower (1.0 mg/kg) dose of diazepam as well as in those of the control group. The present data demonstrate an impaired defence against M. bovis in adult hamsters after in utero exposure to a dosage of 1.5 mg/kg of diazepam.

Ontogeny of diazepam binding inhibitor/acyl-CoA binding protein mRNA and peripheral benzodiazepine receptor mRNA expression in the rat

The Diazepam Binding Inhibitor/Acyl-CoA Binding Protein (DBI/ACBP) has been implicated in different functions, as acyl-CoA transporter and as an endogenous ligand at the GABA(A) receptor and the peripheral benzodiazepine receptor (PBR). The latter is thought to be involved in control of steroidogenesis. We studied the ontogeny of DBI/ACBP and PBR mRNA expression in embryos and offspring of time-pregnant Long Evans rats by in-situ hybridization with 33P-endlabelled oligonucleotides. Both mRNAs were present in embryo and placenta at gestational day (G)11, the earliest stage studied. DBI/ACBP mRNA was strongly expressed from embryonic through mid-foetal stages in central nervous system (maximum in neuroepithelium), cranial and sympathetic ganglia, anterior pituitary, adrenal cortex, thyroid, thymus, liver and (late foetal) brown adipose tissue, moderately in testis, heart, lung and kidney. In brain, a late foetal decrease of DBI/ACBP mRNA was followed by an increase at postnatal day 6. Peripheral benzodiazepine receptor mRNA expression started very low and increased to moderate levels in adrenal cortex and medulla, testis, thyroid, brown adipose tissue, liver, heart, lung, salivary gland at mid- to late-foetal stages. Data suggest a significant role of DBI/ACBP at early developmental stages. Both proteins may be involved in the control of foetal steroidogenesis. However, differences in developmental patterns indicate that additional functions may be equally important during ontogeny, such as the involvement in lipid metabolism in the case of DBI/ACBP.

Benzodiazepines, anxiety and immunity

Experimental and clinical studies suggest that the central and peripheral benzodiazepine (BDZ) receptors together with their ligands form the molecular basis of a novel regulatory network that contributes to the effects of anxiety on immune status. The peripheral-type receptors located on phagocytes and glial cells appear to play a key role in mediating the effects of endogenous and exogenous BDZs both on the defence mechanisms that protect the host against pathogens and on inflammatory reactions that take place within the periphery and the brain in response to injury. In addition, the central-type receptor, which forms part of the gamma-aminobutyric acidA receptor complex, may contribute to the regulation of T-cell function by modulating the activity of the hypothalamo-pituitary-adrenocortical axis or the sympathoadrenal system or both, which, in turn, exert a significant effect on immune function. Thus, anxiogenic BDZs in general suppress the immune response, whereas anxiolytic BDZs may protect the individual from stress-induced immunosuppression.

Immune response of adult rats is altered by administration of diazepam in the first postnatal week

The potential immunotoxic risk of perinatal treatment with diazepam was investigated using early postnatal administration of the drug to the rat and monitoring the immune response until the age of 24 months. Rats given a single dose of diazepam 10 mg/kg SC on the seventh postnatal day revealed at the age of 6 months a depression of cell-mediated immune response, and at the age of 12 months significant decrease of humoral immune response. The latter persisted until senescence (age 24 months). Also, a repeated dosage of diazepam (3 x 5 mg/kg/day SC on postnatal days 5 to 7) induced a significant depression of humoral immune response in 7-month-old rats. The results demonstrate that both the humoral and cell-mediated immune response of adult rats can be altered by administering diazepam in early postnatal life.

Impaired host resistance to Trichinella spiralis as a consequence of prenatal treatment of rats with diazepam

In utero exposure of Long Evans rats to low dosages of diazepam has previously been found to result in depression of cellular and humoral immune responses until adulthood, with marked changes in cytokine release by splenocytes and splenic macrophages. In order to assess the significance of these alterations in immune cells with regard to host resistance, we investigated the resistance of adult offspring towards Trichinella spiralis. Time-pregnant rats were treated with diazepam (1.25 mg/kg/day) or vehicle from gestational day 14 to 20. Male offspring were infected with T. spiralis at 2 months of age. This infection model tests the participation of T- and B-cell populations and of macrophages. Prenatally diazepam-exposed animals exhibited an impaired defence towards T. spiralis. The number of muscle larvae was increased as determined in digested carcasses and by morphometric analysis of the tongue. Moreover, antibody titers were altered, i.e., IgG was decreased and IgA was elevated in the prenatally diazepam-exposed group. These results demonstrate an impaired defense towards T. spiralis in adult rats after prenatal exposure to diazepam.

Diazepam treatment of pregnant rats differentially affects interleukin-1 and interleukin-2 secretion in their offspring during different phases of postnatal development

Treatment of pregnant Long Evans rats with benzodiazepines was found to cause alterations in cellular immune responses in their offspring. We now report on changes in interleukin-1 (IL-1) and IL-2 secretion which were analyzed in rats from birth until 12 weeks. Time-pregnant rats were treated with diazepam (1.25 mg/kg/day subcutaneously) from gestational day 14 to 20. Lipopolysaccharide-stimulated release of macrophage-derived IL-1 by spleen cells, determined on D10.G4.1 cells, remained in the control range during the preweaning period (postnatal day 6-28), then decreased in prenatally diazepam-exposed offspring, significantly in males during the postweaning period (postnatal day 34-61) and in both sexes in adults (postnatal day 62-83). Concanavalin A-stimulated release of T lymphocyte-derived IL-2 from spleen cells, determined on CTLL-2 cells, was reduced in male and female offspring during preweaning (postnatal day 3-28) and postweaning (postnatal day 33-55) periods and normalized in adulthood (postnatal day 60-84). The percentage of IL-2 receptor expressing (CD25+) cells was unaffected. From these and our earlier data it is evident that prenatal exposure to low doses of benzodiazepines can result in long-lasting alterations of the cytokine network, as indicated by reduced release of TNF-alpha, IL-1, IL-6, IL-2 and interferon-gamma. The concomitant reduction of peripheral type benzodiazepine receptors on macrophages is discussed as a possible link between prenatal treatment and disturbed function.

Prenatal exposure to diazepam causes sex-dependent changes of the sympathetic control of rat spleen

Prenatal exposure to low doses of benzodiazepines has been found to affect immune functions (25,26). Because the immune system is controlled by the autonomic nervous system, we investigated the sympathetic activity in the spleen for a possible contribution to impaired immune function. Twenty-eight-day-old offspring of prenatally diazepam- or vehicle-treated Long-Evans rats (diazepam 1.25 mg/kg/day SC, gestational day 14-20) were injected IP with sheep red blood cells (SRBC) to evoke an immune reaction. Baseline splenic noradrenaline (NA) turnover was higher in females than in males. Prenatal diazepam treatment resulted in reduced NA turnover in the spleen of SRBC-stimulated female, but not male, offspring. beta-Adrenergic binding sites in spleen membrane fractions, studied with 3H-dihydroalprenolol, showed no differences, indicating that changes in NA turnover were not compensated by changes in receptor expression. Sex-specific developmental effects of diazepam have been described earlier, e.g., in selective effects on perinatal corticosterone levels in female offspring (26).